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. I, I' u.rlt IiAA.rcl have read and fully u:aderstaDd and agree to the provisi0D8 of this instrument. D:ISCLOS'ORB STATBMBII'.L' I'OR OWBBR CI:TY OP ZBPBYRB:ILLs BUU.DXBG DBPAllT.lllD1T The UDdersigned states and affizms that he or she is desirous of COlUlt:ructing, renovating, ......h..9' to or reroofU1g Ms or her own ~ci1e, that he or she actuaJ.ly occupies, or 1d.11 occupy by said ~cile, and same is not for rent, J.ease or sal.e. ftat he or she shaJ.l comply 1d.th the foJ.low:ing ccmd:i.ti0D8: J.. ftat the owner and he or she al.one sJaaJ.l act as the builder for al.J. phases of cOlUJtruction. 2. That the mmer 1d.ll c0l8p1y with al.1 provisiQIUJ of the City of ZephyrM11s ordi ft"l1C'es and codes pertinent to the building. 3 . That in the event various phases of CODSt:ruction are subcontracted, he will engage onl.y properly licensed 81Jbccm.tractors and 1d.ll p&rSonaJ.ly supervise such work.. 4. '!'hat in the event the Builc:ling I:Dspector shal.1 require correctiQIUJ to be made, the owner wi11 assume ful.1 respoDilibllity to insure they are 1Ulde, and upon c0lllp1etion wi11 caJ.1 for a reiDspection before proceeding with the bui1ding. 5. ftat the owner shaJ.l as8'lDle ful.l resp01udbi1ity for the ccmat:ruction aDd wi11 not expect supervision of Ms work frcm the City of Zephyrhills Building Depart::ment. 6. That prior to final. inapecticm. any a.d4i.tiona.l. fees, including reinspection fees, DII18t be paid in ful.1. A written request from this office sha.J.1 cOlUltitute an official. notice to pay additional. fees. 7. That the owner shaJ.l cCllllply with &11 City, State aDd. PederaJ. laws in regard to social. security, workman's c~.ation, lien laws, etc., where applicable. 8. That the owner shal.l comply with al.l the safety codes issued by the norida Industrial. COlll8lission. 9. State 1aw requires construction to be done by licensed contractors. You have applied for a permit 1JDder an ezeaption to that 1aw. The exemption al.lows you, as the owner of your property, to act as your own contractor with certain restrictiQIUJ even though you do not have a 1iC8DSe. You must provide direct ODSite supervision of the conatruction yourself. You may build or imprcwe a oue-fami1y or two-family residence or a f&X'Dl outbui1ding. You may al.so bui1d or improve a cCMlllll8rcial. bui1diDg, provided your costs do not exceed. $25.000. The building or residence must be for your own use or occupancy. It may not be built or substantia1ly improved for sal.e or 1...e. :If you sell or 1ease a - bui1ding you have bui1t or substantiaJ.ly improved yourself within 1 year after the COlUltruction is complete, the law wi11 presume that you bui1t or substantiaJ.1yimproved if for sale or 1...e, which is a vi01ation of this exemption. You may not hire an UDJ.iceused. persOn to act as your COD.tr&ctor or to supervise peep1. working on your bui1ding. :It is your responsibi1ity to make sure that people 8IIIployed by you have licenses required by state 1aw and by COlUlty or DI11Di.cipal. licensiDg ord"uances. You may not del.egate the responsibi1ity for supervising work to a 1iC8D8ed contractor who is Dot 1icensed to perform the work being done. Any person working OD your building who is not licensed aust work UDder your direct: supervision aDd. DlUSt be eap10yed by you, which ...us that you aust cieduct P.I.C.A. and wit:hholding tax &Dei provide workers' cCIIIIp8DSatiOD for that eapl.oyee, all. as prescribed by 1a . Your CODSt:ruction DlUS amp1y aJ.1 app1icab1e 1aws, or..ift......ces, bui1 codes, and zODing r tions. OWBIl'S ADDRBSS PlIORB DATE wrr.tIBSS' PBRIIn" .